Damage control in the abdomen and beyond

Loveland, Jerome; Boffard, Kenneth D.

doi:10.1002/bjs.4641

Cited by 89 publications

(48 citation statements)

References 57 publications

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“…Stent-grafts may also be used to treat traumatic dissections in the remaining part of the aorta. (17)(18)(19) Standards urgical practice teaches that the best operation for ap atient is one, definitive procedure. Damage control surgical principles teach the exact opposite, namely that the patient with major exsanguinating injuries is morel ikely to die of metabolic failuret han from failuret od efinitive repair.D CS is the principle of surgically maintaining the oxygen transport in the injured patient who is deteriorating and will not tolerate longlasting, definitive surgery.…”

Section: Splenic Injuriesmentioning

confidence: 99%

Scandinavian Guidelines — “The Massively Bleeding Patient”

et al. 2008

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16C. Gaarder et al. the prehospital careprovider with amoreorless obvious mechanismo fi njury,c omplaintsa nd symptoms, and with many uncontrolled factors making both diagnosis and triage achallenge.Vo lume loading results in adecrease in haemoglobin and clotting factors. Furthermore, the relative expansion with 500 ml of isotonic crystalloid is greater in as hocked person than in ah ealthy individual. The optimal volume of intravenous fluid to administer is abalance between avoiding hypovolaemia and not increasing systolic blood pressure(SBP) causing disruption of clots and further bleeding. To what extent this is moret han at heoretical worry in patients with blunt trauma, is not well documented. Several animal models of penetrating injury,h owever,h ave documented the relationship between increasing blood pressure, increased bleeding and fatal outcome.AS BP <90m mH gi su sed extensively to assess volume status in trauma patients, both for triage, treatment and study protocols. How well aSBP <90 mm Hg defines the presence of uncontrolled bleeding, the need for intravenous fluid resuscitation and later surgical interventions is still not clear.T herei s also some evidence to support the use of only manual SBP for pre-hospital, or hospital, triage decisions (1).In EMS (Emergency Medical Services) systems wherep re-hospital fluid therapy is used, the incidence of hypotension at hospital admission is lower than 10% and the need for immediate haemostatic surgery is low (5). Recent publications have reinforced the impression that fluid resuscitation and blood transfusion in the Emergency Department still aree ssential elements of early management in most critically injured patients. Hence, providing the same therapy earlier,i fn ot exaggerated, seems logical. A major concern with prehospital fluid therapy is that infusing cold fluids will cause hypothermia in the patients, afactor known to reduce clotting activity.Patients with severeT BI (traumatic brain injury) do not tolerate even short periods of hypotension. Hence, theu se of volume therapy to counteract hypovolaemia and hypotension is considered standard treatment by most authors. The discussion has been focused moreonwhat systolic blood pressuretoaim for and what fluid to use. RECOMMENDATIONS

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Section: Splenic Injuriesmentioning

confidence: 99%

Scandinavian Guidelines — “The Massively Bleeding Patient”

et al. 2008

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“…Um conceito importante que precisa ser incorporado é a abordagem cirúrgica com "controle de danos" (Damage control) ou laparotomia abreviada. Trata-se da manutenção de um ambiente anatômico estável para impedir a progressão das alterações fisiológicas para um estado metabólico irreversível, uma vez que os pacientes morrem mais freqüentemente de déficits funcionais (hipotermia, acidose metabólica intratável e estado de incoagulabilidade sanguínea) do que do reparo anatômico completo dos órgãos 30 . A opção por esta abordagem cirúrgica deve ser tomada tão logo se constate os déficits metabólicos do paciente e faça os controles dos sangramentos e das contaminações intestinais mais grosseiras.…”

Section: 2-tratamento Cirúrgicounclassified

“…É feita a compressão da cavidade peritoneal, com os órgãos mantidos na sua posição anatômica utilizando-se compressas cirúrgicas (packing abdominal) e, é realizada a síntese temporária da parede abdominal. O paciente é internado em ambiente de terapia intensiva para controle dos déficits fisiológicos e, em 24 a 48 horas, após o controle da temperatura corpórea, da coagulação sangüínea e da acidose metabólica, será levado novamente ao centro cirúrgico para a correção anatômica definitiva das lesões 30 . Outra abordagem cirúrgica que pode ser utilizada em situações especiais são as relaparotomias programadas (second look), principalmente, no caso de dúvidas sobre a viabilidade de alças intestinais, anastomoses com risco de deiscência, necrosectomias e infecções peritoneais graves 30 .…”

Section: 2-tratamento Cirúrgicounclassified

Abordagem Geral Trauma Abdominal

Júnior

Lovato

Carvalho

et al. 2007

Medicina (Ribeirão Preto)

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RESUMO:O trauma abdominal é freqüentemente encontrado em situações de emergência. A falta de história adequada do mecanismo de trauma e a presença de lesões que podem ter dor irradiada para o abdome ou a alteração do estado mental, devido a trauma cranioencefálico ou intoxicação por drogas depressoras do sistema nervoso central, podem dificultar o diagnóstico e o tratamento do trauma abdominal. Os pacientes que são vítimas de trauma, freqüentemente, têm lesões intra e extra-abdominais associadas.Este artigo de revisão irá discutir a abordagem geral do atendimento dos pacientes com traumas abdominais contusos e penetrantes, incluindo as opções de testes diagnósticos e as considerações acerca do tratamento inicial.Descritores: Traumatismos Abdominais. Ferimentos Penetrantes. Ferimentos não Penetrantes. Avaliação. Tratamento. 1-INTRODUÇÃOO traumatismo abdominal é responsável por um número expressivo de mortes evitáveis. A cavidade intraperitoneal, juntamente com a cavidade torácica, o espaço retroperitoneal (sobretudo na presença de fraturas de bacia) e as fraturas de ossos longos, são os locais do organismo que comportam sangramentos capazes de levar à morte por choque hemorrágico 1 . O mecanismo de trauma, a localização da lesão e o estado hemodinâmico do paciente determinam o momento da avaliação do abdome 1 . Boa parte dos quadros de hemoperitônio decorrentes de uma lesão visceral abdominal são oligossintomáticos 1 . Além disso, os sintomas abdominais relacionados ao traumatismo, muitas vezes, são obscurecidos por lesões associadas com dor referida ou, por alterações do nível de consciência, principalmente, decorrentes do trauma craniano, o que dificulta a sua avaliação. Portanto, uma avaliação rigorosa do abdome e uma correta orientação irão reduzir os erros na interpretação e os impactos desfavoráveis na evolução do paciente 1,2 . 2-HISTÓRIA E MECANISMO DE TRAUMAAs informações colhidas da vítima, quando possível, ou dos socorristas que efetuaram operação de resgate são valiosas. As noções da biomecânica do trauma, o estado inicial da vítima no local de atendimento, diagnósticos realizados, a resposta à infusão de fluidos no início e o tempo decorrido desde o trauma irão auxiliar na suspeita de lesão abdominal 2 .Nos casos de colisões automobilísticas, as se-

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“…[4,5] Trauma-associated coagulopathy was originally thought to be primarily due to hypothermia, acidosis and consumption/dilution of clotting factors. [6] Current studies have revealed that neurohormonal activation, systemic inflammation and widespread endothelial damage may similarly have an important influential role, and the etiology of traumarelated coagulopathy is multifactorial. [7,8] Much mystery still surrounds changes in coagulation taking place in the period after injury.…”

Section: Introductionmentioning

confidence: 99%

Diverse coagulopathies in a rabbit model with different abdominal injuries

Peng

Zhao

2017

World Journal of Emergency Medicine

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BACKGROUND: Although coagulopathy can be very common in severe traumatic shock patients, the exact incidence and mechanism remain unclear. In this study, a traumatic shock rabbit model with special abdomen injuries was developed and evaluated by examining indicators of clotting and fi brinolysis. METHODS:Forty New Zealand white rabbits were randomly divided into four groups: group 1 (sham), group 2 (hemorrhage), group 3 (hemorrhage-liver injury), and group 4 (hemorrhage-liver injury/intestinal injury-peritonitis). Coagulation was detected by thromboelastography before trauma (T 0 ), at 1 hour (T 1 ) and 4 hours (T 2 ) after trauma. RESULTS:Rabbits that suffered from hemorrhage alone did not differ in coagulation capacity compared with the sham group. The clot initiations (R times) of group 3 at T 1 and T 2 were both shorter than those of groups 1, 2, and 4 (P<0.05). In group 4, clot strength was decreased at T 1 and T 2 compared with those in groups 1, 2, and 3 (P<0.05), whereas the R time and clot polymerization were increased at T 2 (P<0.05). The clotting angle signifi cantly decreased in group 4 compared with groups 2 and 3 at T 2 (P<0.05).CONCLUSION: This study suggests that different abdominal traumatic shock show diverse coagulopathy in the early phase. Isolated hemorrhagic shock shows no obvious effect on coagulation. In contrast, blunt hepatic injury with hemorrhage shows hypercoagulability, whereas blunt hepatic injury with hemorrhage coupled with peritonitis caused by a ruptured intestine shows a tendency toward hypocoagulability.

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Damage control in the abdomen and beyond

Cited by 89 publications

References 57 publications

Scandinavian Guidelines — “The Massively Bleeding Patient”

Scandinavian Guidelines — “The Massively Bleeding Patient”

Abordagem Geral Trauma Abdominal

Diverse coagulopathies in a rabbit model with different abdominal injuries

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